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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIUNS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PE MIT# � <br /> 2o Cl� ��lti �{r'. 7 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DE50. <br /> OWIJER ADDRESS CITY/ZIP PHONE <br /> S c��(-" �oc:.k.tnrC4/� Bo�o cw-(�(S-v. d-(r �,u '�+ti� �l'k,tyZ3 ZOb 7l S�S�S- <br /> TENANT NAME C NTA�T FOR PERMIT PHONE <br /> I �w(� (�acic�.l ( 7,o��lS -gYS <br /> CONTRACTOR ,i7��(�CI C,(1 .S/�_L.:L n�DDRESS CITY2IP PHONE <br /> �w 1 vVt l Y � <br /> CONTR.UCENSE# ��i ��Gl�p� �/'� �, � �� ���� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> t, '�.,� ,b'p n�r rl � ,_,Eleclric _Gas_Olher <br /> �--�i irxl n/ � <br /> WORK DESCRIPTION � "� <br /> � �i'��l'r�- ��� �,t,��,;� -�i�'Dw� `�ll� <br /> R +�� � � <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ AIC—air handling unils <br /> 6athlub Forced air systems <br /> _ Lavalory(wash basin) � Gas pipiny <br /> Shower Water heater <br /> Kitchen sink 8 disposal _� Gas fireplace <br /> Disliwashcr 1 Gas rango <br /> C{ethes washer r Clothes dryer <br /> Waler healer _ Range hood <br /> Sink(service/bar/mop/elc.) _ Exhausl fan <br /> Backllow prevenler _ Heat pump <br /> Urinal _ Unil heater <br /> Drinkinc� Founlain _ Boiler <br /> Floor drain _ Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined this applicalion and know the same lo be lrue and correcl AII provisions of laws and <br /> ordinaces c�oveming lhis lype o(work will be complied�vith whelher specified herei�or not.The granling of a permil does nol presume <br /> lo give aulhority to violale or cancel lhe provision of any other slate ot local law regulatinc� consWction or lhe performance oi <br /> construclion.Thal I am auUiorized by lhe owner of lhis property to pedorm the work for which application is made and I comply wilh lhe <br /> State_Contraclors Law 1827 RCW and 29G.2U0 WAC. <br /> o �1 ��t ( 0� <br /> �ivr.i� � �1� D le <br /> �nature ot OwnedContr'actodAuthonzed Ac�enl <br />